The ACOG Is Saying To Leave Low-Risk Laboring Moms Alone, And It's About Freaking Time
I don’t know about you, but when I was in labor with my kids, I wanted nothing more than to be left the hell alone. No, I didn’t give birth in a hut without any medical professionals present, but giving birth felt like maybe one of the most private, personal things that I was going to do, and the last thing I wanted was to be hooked up to a million machines or to have an audience of 15 20-something interns watching me push a baby out of my vagina.
Because I was considered low-risk, I was able to give birth with a midwife, who let me do my thing in relative peace. Both of my labors started with my water breaking, but it took a few hours before labor began. My midwife didn’t do anything to speed things along. She trusted the process of labor, and let it happen. I wasn’t hooked up to an electronic fetal monitoring machine. My baby’s heartbeat was checked periodically by the midwife with a handheld Doppler. This made it possible for me to labor and push in any position I wanted to.
Now, I realize that my births sound totally crunchy. They were. I had doulas, we lit candles, and I chose to forgo pain medication. I absolutely understand why some mothers want epidurals, and if I had wanted one, I would have gone for it, no questions asked — and no guilt. I also understand that I am super-lucky to have had totally uncomplicated pregnancies and births, and I wasn’t in need of many of the lifesaving interventions that the medical world has to offer.
But I also wish that more mothers had the opportunity to have a birth experience like mine, where their body was trusted to do its thing, and where they were given the respect of privacy and autonomy. And I have hoped that more low-risk women were given the option of birthing without medical interventions, unless necessary.
That’s why I was stoked when I saw that the American Congress of Obstetricians and Gynecologists (ACOG) recently released new guidelines for maternity care providers, basically saying what I’ve been saying for years, that medical interventions should be limited when it comes to low-risk laboring moms.
In a statement on the ACOG website, Jeffrey L. Ecker, M.D., the Committee Opinion author, describes in more detail what the guidelines mean for providers: “These new recommendations offer providers an opportunity to reexamine the necessity of obstetric practices that may have uncertain benefit among low-risk women. When appropriate, providers are encouraged to consider using low-intervention approaches that have been associated with healthy outcomes and may increase a woman’s satisfaction with her birth experience.”
The statement defines a low-risk mom: a woman who had an uncomplicated prenatal period, is full-term, and has had a spontaneous labor (i.e., labor that started on its own). For these women, the committee recommends staying home in the early stages of labor, and waiting until 5- or 6-centimeters dilated to be admitted to the hospital.
Once in the hospital, the committee explains that these women do not need continuous fetal monitoring unless necessary; they should be allowed to labor and push in any position they choose; and women whose labors are progressing normally don’t need their waters artificially broken. If a mother’s water breaks on its own, the committee recommends a wait-and-see approach when it comes to induction, if it has been determined that the mother and baby are faring well.
And if that wasn’t crunchy enough sounding for you, the committee also recommends that all laboring women be given the emotional support of a labor coach or doula, adding that doula care is associated with shorter labors and fewer C-sections. The committee says that epidurals should be an option for all women, but massage, relaxation techniques, and water immersion (in the first state of labor) are also recommended.
However we choose to cope with the pain, I think we can all agree that none of these things can hurt, and that probably all moms could use the emotional support offered by someone like a doula or labor coach. The committee believes this is win-win for mother and for hospitals and providers. “Providing emotional support and coping mechanisms have proven positive outcomes, therefore, it’s recommended that providers consider instituting policies that allow for the integration of support personnel in the labor experience,” write the ACOG committee. “This strategy may be beneficial for patients and cost effective for hospitals due to an association with lower cesarean rates. It is important that midwives, OB-GYNs, and other care providers collaborate to support women both emotionally and physically over the course of labor.”
Lower interventions, fewer C-sections, doulas for everyone, and emotionally available OBs and midwives? I think we can all get on board with that. Of course, it remains to be seen how some of this will be implemented. For example, everyone having a doula or labor coach sounds awesome, but who is going to fund that when it’s rarely covered by insurance? And so many of these interventions are such a routine part of hospital procedure that it’s hard to imagine hospitals magically implementing these new guidelines.
Still, it’s a welcome recommendation, and something for all us to consider. Birthing moms deserve the best, whether what they need is more medical attention or less. However mothers wish to birth, their thoughts and feelings must be heard, valued, and accommodated as much as possible — and these new guidelines from ACOG are a step in that direction.
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